The Pharmaceutical Journal
Vol 270 No 7253 p828
14 June 2003

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Letters to the Editor

Statin therapy

Some groups of patients that could benefit are neglected

From Mr P. D. Burrill, MRPharmS

In their interesting article (PDF 55K) on cholesterol management (PJ, 17 May, p688), Helen Williams and Mel Stevens seem to be neglecting some groups of patients who could benefit from statin therapy. I am concerned that readers may misinterpret this.

The authors recommend statin therapy is targeted at patients with established coronary heart disease (secondary prevention) and primary prevention in those with a 30 per cent or greater 10-year risk. They also mention that statin use is supported in people with diabetes and reference the Heart Protection study (HPS).¹

HPS is the largest randomised trial of CHD prevention to date and should profoundly influence how statins are prescribed. Two key groups in the HPS study (as well as CHD patients and people with diabetes) were patients with established peripheral vascular disease (PVD) and patients with cerebrosvascular disease (CVD), both without CHD.

The patients with PVD were at the same five-year risk of a vascular event (30.5 per cent) as patients with a prior myocardial infarction (29.4 per cent). Most importantly, these three groups of patients, established CHD, PVD or CVD, all achieved similar benefit from simvastatin 40mg daily in terms of the number needed to treat (NNT) to prevent a vascular event over five years (range 17 to 20). People with diabetes aged over 40 but with no CHD also benefited to a remarkably similar degree (NNT of 21) and should now arguably be regarded as secondary prevention.

It is important that patients with established CHD, PVD or CVD, and people with diabetes aged over 40 are targeted for therapy with simvastatin 40mg daily with equal vigour. Ensuring that these groups receive this treatment will lead to substantial clinical and public health benefits.

Peter Burrill
Specialist in Pharmaceutical Public Health
North Derbyshire Public Health Network

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